联用血流储备分数较单纯冠脉造影用于冠状动脉粥样硬化性心脏病治疗的成本-效果分析  

Cost-effectiveness analysis of coronary angiography combined fractional flow reserve compared with coronary angiography alone for the treatment of coronary atherosclerotic heart disease

作　　者：郭佳瑜 唐紫君 应晓华[1] GUO Jiayu;TANG Zijun;YING Xiaohua(School of Public Health,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学公共卫生学院,上海200032

出　　处：《世界临床药物》2023年第6期653-660,共8页World Clinical Drug

摘　　要：目的 从中国医疗卫生系统角度,比较应用血流储备分数(fractional flow reserve,FFR)联用冠状动脉造影(coronary angiography,CAG)对比单纯CAG在指导冠状动脉粥样硬化性心脏病诊断及治疗中的成本和效果。方法 构建卫生经济学评估模型(短期决策树加长期马尔科夫模型),模型每个周期长度为1年,模拟周期为10年。借助模型比较应用FFR联用CAG组(下简称FFR组)对比单纯CAG组(下简称CAG组)在冠状动脉狭窄程度上的差异,分析两种治疗方式下构成差异并测量成本-效果。结果 FFR组总成本为109 434元,对应效果为7.75质量调整生命年(quality adjusted life years,QALYs);CAG组总成本为120 722元,对应效果为7.65 QALYs。相较于CAG组,FFR组的增量成本-效果比(incremental cost-effectiveness ratio,ICER)为-112 460元/QALYs。结论 FFR组相比于CAG组更具有成本-效果。其优势来源于FFR组通过对冠状动脉功能性病变的精确诊断帮助医生准确判断患者冠状动脉狭窄程度以及治疗方式,避免不必要的经皮冠脉介入术手术和支架植入,改善患者生命质量,降低并发症的医疗成本。Objective To compare the cost and effectiveness of fractional flow reserve(FFR)combined with coronary angiography(CAG)versus CAG alone in guiding the diagnosis and treatment of coronary atherosclerotic heart disease from the perspective of China's medical and health system.Methods The evaluation model of health economics(short-term decision tree plus long-term Markov model)was constructed.The length of each cycle of the model was 1 year,and the simulation period was 10 years.The model was used to compare the difference in the degree of coronary stenosis between FFR combined with CAG group(FFR group)and CAG group.The difference in the composition of the treatment methods of the two groups were analyzed and the cost-effectiveness was measured.Results The overall cost of FFR group was 109434 Yuan,and the corresponding effect was 7.75 quality adjusted life years(QALYs).The overall cost of CAG group was 120722 Yuan,and the corresponding effect was 7.65 QALYs.Compared with CAG group,the incremental costeffectiveness ratio of FFR group was-112460 Yuan/QALYs.Conclusions FFR group is more cost-effective than CAG group.The advantage of FFR group comes from the accurate diagnosis of coronary functional lesions to help doctors accurately determine the degree of stenosis and treatment methods,avoid unnecessary percutaneous coronary intervention surgery and stent implantation,improve the quality of life of patients,and reduce the medical cost of complications.

关 键 词：血流储备分数 冠状动脉造影 成本-效果分析 

分 类 号：R541.4[医药卫生—心血管疾病] R95[医药卫生—内科学]